Wide variations in the use, practices, and complications involving peripherally inserted central catheters (PICCs) were seen across 10 hospitals in a quality-control network in Michigan, researchers reported.
Depending on the facility, difficult venous access was responsible for only 10% of PICCs in some hospitals, but up to 64% in others, and complication rates also ranged anywhere from 4% to 36%, among 3,201 patients who received a PICC during a 14-month period, reported Vineet Chopra, MBBS, of the University of Michigan in Ann Arbor, and colleagues, in a research letter inJAMA Internal Medicine.
Chopra has led a team to develop the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) guidelines, an evidence-based algorithm for PICC use, which they published in 2015.
The inconsistencies that Chopra’s group identified are seen across the U.S., commented Lois Davis, MSN, RN, director of professional development at the Association for Vascular Access in Herriman, Utah.
“There are complications associated with any vascular access device used, and we know there’s inconsistencies in practice, and a lot of those happen because there are a bunch of different guidelines out there, and there are differences among all of them,” Davis said in a phone interview with MedPage Today.
Part of the variability across hospitals could have to do with whether the facility had a PICC specialty team, she explained, adding that dedicated teams are optimal. Also, several medical organizations produce their own PICC guidelines. “The problem is that everybody has their own, and trying to get them to be consistent [is key]. Education is huge,” she said.
She added that the development of MAGIC guidelines should support the necessary consistency in practice to improve outcomes.
Chopra’s group looked at 10 hospitals that were involved in a quality-improvement initiative focused on preventing adverse events among hospital patients, known as the Michigan Hospital Medicine Safety Consortium (HMS).
From 2013 to 2015, trained data researchers at each of the 10 hospitals analyzed patient records, identifying laboratory, medication, intervention, and condition information.
Overall, the researchers found 3,201 patients who had received 3,378 PICCs. The majority (71%) of the PICCs were placed by vascular access nurses, and double-lumen devices were used in 53% of instances.
The median dwell time for PICCs, across all locations, was 10 days, and 24% of them were removed within 5 days of placement. The follow-up period did not exceed 60 days.
The most-reported reason for PICC insertion was “difficult venous access,” which was indicated in 41% of cases. This was followed by at-home antibiotic administration in 29% of cases.
There were PICC-related complications in 19% of cases, the most frequent of which (10%) was catheter occlusion.
In 5% of cases, deep vein thrombosis and pulmonary embolism occurred, and these complications were more common among patients in the ICU setting compared with those in a non-ICU setting (6% versus 5%, P=0.06).
Actual cases of central line-associated blood-stream infections were rare and confirmed in only 1% of cases, but PICCs were removed by physicians who suspected this type of infection in 2% of cases.
PICC use varied across hospitals, anywhere from 3% to 8%, and that could not be explained by the severity of patient illness, or any hospital factors, such as bed number, patient volume, teaching versus nonteaching, or urban versus rural, the authors noted.
Indication for PICC use, along with complications and the type of complication, also varied widely across hospital. For instance, in the case of difficult venous access, this indication prompted 10% of PICC placement in some locations, but up to 64% of PICC placement in others (P<0.001). Complications were as low as 4% to upwards of 36%, or 0.041 to 0.406 complication per PICC (P<0.001).
And at six hospitals, catheter thrombosis was the most common type of complication, whereas venous thromboembolism was the most frequent at two hospitals.
The authors concluded that “understanding how best to implement MAGIC guidelines across hospitals is thus an important next step that will both inform quality improvement efforts and improve the safety of venous access in hospitalized patients.”